Medical missionary Dr. Albert Schweitzer carried a copy up the Ogooue River in Africa. Rear Adm. Richard E. Byrd packed one in a sled as he crossed the Antarctic ice. Generations of general practitioners have relied on it. Military doctors and feverish Peace Corps volunteers have profited from its pithy counsel.
It is the Merck Manual, a book that tries to cram 1,800 years of Western medical tradition into a one-volume encyclopedia. This year marks its centennial. To celebrate, the hefty 17th edition comes packaged with a facsimile of the first, published in 1899.
The manual's century-long publishing history parallels the rise of modern medicine and pharmacology. And the slim first edition demonstrates just how far those scientific disciplines have come.
FOR THE RECORD - An article on the Merck Manual in yesterday's editions incorrectly named the editor of the publication. He is Dr. Robert Berkow. The Sun regrets the error.
The 1899 Merck recommends 75 drugs for treating diphtheria -- including the liberal use of alcohol -- and 96 for gonorrhea. But this was the age before antibiotics, and none of the primitive nostrums had a prayer of working.
The manual also prescribes 38 therapies for rabies, including a diet of asparagus and a course of acupuncture. Again, none of these therapies were effective. Once symptoms appear, the disease is still always fatal.
Acute bronchitis? Try bleeding the patient, the manual suggests. Your teen-ager suffers from acne? Dose him with arsenic.
Yes, the manual recommends quinine for malaria -- still sound advice. But it also suggests mercury, a powerful toxin. In those pre-Viagara days, impotence called for a swig of turpentine oil or strychnine.
"Some of this stuff is pretty wacky," says Dr. John S. Andrews, who teaches pediatrics at the Johns Hopkins University's school of medicine. "Strychnine? There's no medical use for strychnine now."
He was struck by the 1899 edition's unbounded, and unfounded, confidence. "What tickles me the most about it is how very specific the recommended medications and dosage are, and how limited the knowledge must have been."
More than just a reference work, the original 192-page Merck's Manual was a pioneering marketing scheme. The name MERCK is printed in bold letters after every drug manufactured by the company. What better place to push pills than in a book designed for doctors to carry around in their coat pockets? Patients paid for drugs, but doctors wrote prescriptions and could be swayed by ads, too. (Promoting drugs to doctors is still a central sales strategy for pharmaceutical companies.)
